Metformin & lifestyle intervention prevent Type 2 diabetes: lifestyle intervention has the greater effect

Diabetes mellitus is now occurring in epidemic proportions in many countries. Owing to the limited effectiveness of drug prophylaxis of diabetic complications after diabetes has developed, it may be more appropriate to investigate ways to prevent the onset of diabetes. A recent trial published by the Diabetes Prevention Programme Research Group investigated whether lifestyle changes or metformin were effective in delaying the onset of diabetes in subjects with impaired glucose tolerance. The goals of the intensive lifestyle intervention were to achieve and maintain a weight reduction of 7% through a low-calorie, low-fat diet and to engage in physical activity of moderate intensity, such as brisk walking, for at least 150 min/week. The effectiveness of the intensive lifestyle intervention on body weight was initially quite good but decreased over time. Metformin caused some weight loss but to a lesser extent than the intensive lifestyle intervention. Both therapies decreased the fasting plasma glucose levels to a similar extent initially. The intensive lifestyle intervention decreased plasma glycosylated haemoglobin levels to a greater extent than metformin. Both intensive lifestyle intervention and metformin reduced the incidence of diabetes, with the lifestyle intervention having the greater effect.     

Antidepressant use, depression, lifestyle factors, and new-onset diabetes

We assessed the short-term association between antidepressant drug use and the risk of new-onset diabetes in 2-years of observation. This study used longitudinal data from the Medical Expenditure Panel Survey for years 2004-2007. Chi-square tests and logistic regressions were used to examine the link between use of antidepressants with and without depression, and new-onset diabetes, after controlling for independent variables in blocks. In unadjusted models, the risk of new-onset diabetes was significantly increased for persons using antidepressants with depression compared with those without antidepressant use or depression [odds ratio (OR)=2.12, 95% confidence interval (CI): 1.45-3.09]. When lifestyle risk factors were entered in the model, statistical significance disappeared [adjusted OR (AOR)=1.42, 95% CI: 0.98-2.08]. Independently, lifestyle risk factors significantly increased the risk of new-onset diabetes: hypertension (AOR=2.55, 95% CI: 1.86-3.50, P<0.001), lipid disorders (AOR=1.60, 95% CI: 1.14-2.24), overweight (AOR=2.01, 95% CI: 1.35-2.98), obesity (AOR=3.57, 95% CI: 2.50-5.10), and no physical exercise (AOR=1.98, 95% CI: 1.53-2.57, P<0.001). Future studies on the risk of new-onset diabetes by duration and intensity of antidepressant use and depression are needed.     

Metformin & lifestyle intervention prevent Type 2 diabetes: lifestyle intervention has the greater effect

Diabetes mellitus is now occurring in epidemic proportions in many countries. Owing to the limited effectiveness of drug prophylaxis of diabetic complications after diabetes has developed, it may be more appropriate to investigate ways to prevent the onset of diabetes. A recent trial published by the Diabetes Prevention Programme Research Group investigated whether lifestyle changes or metformin were effective in delaying the onset of diabetes in subjects with impaired glucose tolerance. The goals of the intensive lifestyle intervention were to achieve and maintain a weight reduction of 7% through a low-calorie, low-fat diet and to engage in physical activity of moderate intensity, such as brisk walking, for at least 150 min/week. The effectiveness of the intensive lifestyle intervention on body weight was initially quite good but decreased over time. Metformin caused some weight loss but to a lesser extent than the intensive lifestyle intervention. Both therapies decreased the fasting plasma glucose levels to a similar extent initially. The intensive lifestyle intervention decreased plasma glycosylated haemoglobin levels to a greater extent than metformin. Both intensive lifestyle intervention and metformin reduced the incidence of diabetes, with the lifestyle intervention having the greater effect.     

家庭访视对糖尿病患者生活方式的强化干预

目的 采用家庭访视对糖尿病患者生活方式进行强化干预,为患者提供一种更为人性化的、更高层次的健康教育指导,了解糖尿病患者治疗效果及生存质量,为今后开展营养健康教育提供科学依据.方法 对罗定市城区特定20例糖尿病患者采取家庭访视,根据患者个体体质指数、劳动强度,计算每日所需总热量,按“食品交换份法”编制食谱及处方式运动强化干预;并发放综合治疗健康教育指导资料供患者学习.结果 干预后患者饮食摄入总热量、饮食控制、运动、药物、按时检查、自我监测、血糖水平及生化指标显著优于干预前(均P＜ 0.05或P＜ 0.01).结论 家庭访视对糖尿病患者生活方式的强化干预,能提高糖尿病患者对糖尿病知识的认知,显著提高患者对饮食与运动综合治疗的重视度,从而提高患者的生活质量.     

基于循证医学的生活方式赋权综合管理在学龄前期1型糖尿病患儿长期携带胰岛素泵治疗中的应用

目的　探讨基于循证医学的生活方式赋权综合管理在学龄前期1型糖尿病（T1DM）患儿长期携带胰岛素泵治疗中的应用价值。方法　纳入2020年3月至2022年3月郑州大学附属儿童医院内分泌遗传代谢科门诊收治的学龄前期T1DM患儿86例开展前瞻性研究,其中男38例,女48例,年龄（4.71±0.73）岁。根据随机数字表法,分成循证组与常规组各43例。循证组采用基于循证医学的生活方式赋权综合管理,常规组采用常规管理方法。比较两组患儿管理前后糖化血红蛋白（HbA1c）及空腹血糖（FPG）、餐后2 h血糖（2hPG）水平,记录不良事件发生率。经心理弹性量表（CD-RISC）评估患儿照顾者心理状态的变化,分析照顾者对T1DM相关知识的了解程度,采用满意度问卷评估照顾者的满意度。采用χ²检验、秩和检验、t检验。结果　循证组管理3个月后FPG、2hPG、HbA1c分别为（6.34±0.41）mmol/L、（10.97±1.65）mmol/L、（6.42±0.51）mmol/L,低于常规组的（8.19±0.86）mmol/L、（13.64±1.70）mmol/L、（7.91±0.43）mmol/L（t=12.733、7.390、14.647,均P<0.001）。循证组患儿不良事件发生率为4.65%（2/43）,低于常规组的18.60%（8/43）（χ²=4.074,P=0.044）。循证组管理3个月后CD-RISC评分为（88.11±8.55）分,高于常规组的（70.93±6.95）分（t=10.224,P<0.001）。循证组管理3个月后T1DM认知问卷评分为（30.82±2.50）分,高于常规组的（23.81±1.98）分（P<0.05）。循证组照顾者满意率为95.35%（41/43）,高于常规组的79.07%（34/43）（χ²=5.108,P=0.024）。结论　基于循证医学的生活方式赋权综合管理能进一步对学龄前期T1DM患儿血糖进行控制,减少不良事件发生,并提高照顾者对疾病的了解程度与满意度。     

调整生活方式配合“中岳降三高药茶”治疗2型糖尿病的效果观察

目的：探讨调整生活方式配合“中岳降三高药茶”治疗2型糖尿病的临床效果。方法选择初次确诊为2型糖尿病的患者60例为研究对象,将其随机分为研究组和对照组,每组各30例。对照组给予调整生活方式、口服二甲双胍片治疗,研究组在此基础上给予“中岳降三高药茶”治疗。治疗前后测定两组患者的空腹血糖、餐后2h血糖(2 h PG)、胰岛素抵抗指数、空腹胰岛素等相关指标。结果研究组的总有效率为90.0%,对照组为63.3%,两组比较,差异有统计学意义(P<0.01)。两组治疗后的FBG、2 h PG、FINS、HOMA-IR较治疗前均显著改善(P<0.01),且研究组改善更明显,研究组治疗后的FBG、2 h PG、FINS、HOMA-IR均显著低于对照组(P<0.01)。结论2型糖尿病患者在常规治疗基础上服用“中岳降三高药茶”能够显著改善血糖水平,改善胰岛素抵抗情况。     

Preventing type 2 diabetes in high risk patients: an overview of lifestyle and pharmacological measures

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a common disease that is associated with an increased risk of vascular complications. The incidence of T2DM is also increasing. It follows that T2DM prevention is important. METHODS: Relevant articles (review articles, randomised studies and large cohort and case-control studies) were identified through a Medline search (up to March 2005). RESULTS: The first trials on T2DM prevention were based on lifestyle intervention. The results of these studies were impressive since they demonstrated that even a small reduction in weight could significantly reduce the incidence of T2DM. However, the main disadvantage of lifestyle measures is that they are difficult to achieve and sustain. Therefore, pharmacological interventions have also been evaluated. The results of trials using metformin, orlistat, nateglinide, acarbose, thiazolidinediones, hormone replacement therapy, statins or fibrates are either encouraging or require more extensive evaluation. In addition, studies using antihypertensive drugs (mainly angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists) showed that these drugs could also reduce the progression to T2DM in high risk individuals. CONCLUSIONS: T2DM has major quality of life and cost implications. Therefore, more research is needed to establish safe and cost effective ways to prevent this modern epidemic.     

Urge-specific and lifestyle coping strategies of cocaine abusers: relationships to treatment outcomes

This study investigated specific coping techniques for effectiveness in reducing cocaine use after treatment. The urge-specific strategies questionnaire-cocaine (USS-C) assessed frequency of use of 21 strategies for coping with urges. The general change strategies questionnaire-cocaine (GCS-C) assessed frequency of use of 21 lifestyle change strategies designed to maintain abstinence. Cocaine-dependent patients were assessed at follow-up after residential treatment for USS-C (n=59 at 3 months, 84 at 6 months), GCS-C (n=89 at 3 months, 120 at 6 months) and substance use. Less cocaine use was associated with urge coping by thinking about negative or positive consequences, alternative behaviors, distraction, relaxation/meditation, escape, offer refusal, spiritual methods, behavior chains, mastery messages, problem-solving, meeting or sponsor, or seeking social support. The lifestyle change strategies of thinking about consequences, working toward goals, thinking of oneself as sober, clean recreation, regular relaxation, avoiding temptations, not carrying much money, living with clean people, seeking social support, spiritual involvement, keeping busy, and health activities were also associated with less cocaine use. Results suggest focusing coping skills training on these potentially effective strategies.     

糖尿病治疗历史

糖尿病是一种以长期血糖升高为特点的代谢性疾病。人类对糖尿病的认识最早可追溯至公元前1 500年的古埃及。目前对于糖尿病有饮食、运动、药物、代谢手术等多种治疗方式。作者简要回顾了人类对于糖尿病的认识和治疗历史。     

Change of body weight and lifestyle of persons at risk for diabetes after screening and counselling in pharmacies

Objective To investigate the effects of pharmacy based counselling on changes in lifestyle and body weight. Methods Three months after screening a stratified sample of 3,800 randomly chosen overweight persons were addressed with questionnaires. Half a year and 1 year later the assessment was repeated. Standard counselling (SC; non-specific recommendations towards lifestyle), intensive counselling (IC; additional advice to reduce body weight) and counselling for persons at high risk for type 2 diabetes (HRC; recommendation to contact a physician) were compared. Results All counselling groups (SC; n = 557, IC; n = 568, HRC; n = 245) showed significant weight loss three months after screening (0.6–1.9 kg). A further weight reduction was observed at 1 year follow up (1.1–2.4 kg). The HRC group showed a higher percentage of weight loss than the IC or SC group after 3 months (−2.25% vs. −1.20% and −0.67%; P < 0.001) and at 1 year of follow-up (−2.74% vs. −1.54% and −1.29%; P < 0.01). Lifestyle changes in physical activity and/or nutrition were reported by 81.2% in the HRC group, 74.1% in the IC group and 67.0% in the SC group. Conclusion Immediate counselling in community pharmacies after screening for type 2 diabetes can result in significant lifestyle changes and weight loss in overweight individuals.     

Therapeutic lifestyle changes and pharmaceutical care in the treatment of dyslipidemias in adults.

OBJECTIVE: To review each therapeutic lifestyle change (TLC) component listed in the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) cholesterol guidelines and discuss how the guidelines can be used by pharmacists in the treatment of patients with dyslipidemias. DATA SOURCES: Published guidelines and abstracts identified through PubMed (May 1987-March 2004), Medline (January 1966-March 2004), using the search terms cholesterol, hypercholesterolemia, dyslipidemia, hyperlipidemia, diet, saturated fats, unsaturated fats, trans-fatty acids, overweight, obese, exercise, physical activity, program adherence, and guidelines; as well as the NCEP ATP III guidelines, the 2004 ATP III update, National Heart, Lung, and Blood Institute Obesity Guidelines, and Dietary Guidelines for Americans 2005. STUDY SELECTION: Performed manually by author. DATA EXTRACTION: Performed manually by author. DATA SYNTHESIS: TLC components are recommended in the NCEP ATP III guidelines for treatment of patients with dyslipidemias independent of medication use. Dietary modifications are the primary focus of TLC therapy. Saturated fat intake should be limited to less than 7% of total caloric intake and trans-fatty acid intake should be low for patients with dyslipidemias. Persons who are overweight or obese with dyslipidemias should reduce body weight through a combination of physical activity, total calorie reduction, and behavior therapy modifications. CONCLUSION: Pharmacists, given the proper training, can be effective at offering preventive pharmaceutical care for decreasing high blood cholesterol and the risk for coronary heart disease through patient counseling on TLC components as well as drug therapy in patients with dyslipidemias.     

糖尿病药物治疗

<正> 据世界卫生组织1997年报告,全世界明确诊断的糖尿病患者约l.35亿,到2025年将突破3.0亿,发展中国家发病率增长速度大大超过发达国家。1996年我国糖尿病患病率为3.21％,葡萄糖耐量低减发生率(IGT)为4.72％,比1980年全国13省市调查患病率上升了约5倍。老年人糖尿病发生率更     

糖尿病合并高血压的降压治疗

目的探讨糖尿病合并高血压的降压治疗效果。方法将Ⅱ型糖尿病合并高血压患者23例随机分为A组8例、B组7例、C组8例。A组予硝苯地平缓释片;B组采用硝苯地平和缬沙坦联合给药方案;C组采用硝苯地平+吲哒帕胺联合方案。观察对比3组患者治疗前后的血压变化情况及不良反应。结果 3组患者在降压治疗后,其舒张压和收缩压均有显著下降(P<0.01)。其中,B组舒张压下降幅度最大,与其他2组比较差异有统计学意义(P<0.01);C组收缩压下降幅度最大,明显大于另外2组(P<0.01)。A组患者血压达标比率明显低于另外2组(P<0.01)。A组不良反应发生率高于B、C组,差异均有统计学意义(P<0.05)。结论硝苯地平联合血管紧张素转换酶抑制剂或利尿剂能取得较为满意的降压效果,且不良反应少。